What is the most appropriate initial management for this deformity?

A 64-year-old man was referred to the foot clinic. He had tripped over his cat 1 week previously and had complained of an ache in his left foot since then. He had a 12-year history of type 2 diabetes mellitus and hypertension. He was taking metformin, gliclazide, pioglitazone, bendroflumethiazide, ramipril, simvastatin and aspirin.

On examination, his blood pressure was 154/88 mmHg. Foot examination showed absent vibration perception to his ankle. The dorsalis pedis and posterior tibial pulses were easily palpable on both feet.

Investigations:

serum urea12.6 mmol/L (2.5C7.0)

serum creatinine166 µmol/L (60C110)

haemoglobin A1c79 mmol/mol (20C42)

urinary albumin:creatinine ratio8.7 mg/mmol (<2.5)

X-ray of left footsee image

What is the most appropriate initial management for this deformity?
A . bed rest
B . custom-made hospital footwear
C . full contact plaster cast
D . referral for urgent surgery
E . removable aircast boot

View Answer

Answer: C